tbuckley/cabot-search huggingface dataset:
POS0832 MORTALITY TRENDS IN ANCA-ASSOCIATED VASCULITIDES (AAVs): DATA FROM A CONTEMPORARY, MULTICENTER ANCA REGISTRY
Authors: C. Koutsianas, A. Panagiotopoulos, K. Thomas, A. Chalkia, A. Lazarini, N. Kapsala, S. Flouda, E. Argyriou, K. Boki, D. Petras, D. Boumpas, D. Vassilopoulos
Journal: Annals of the Rheumatic Diseases (2022)

Background AAVs are a group of rheumatic diseases with excess morbidity and mortality (~3-fold higher compared to the general population). Long-term studies looking at mortality trends in contemporary patient cohorts are limited. Objectives To investigate the overall long-term survival and all-cause mortality in a contemporary AAV patient cohort. Methods Multicenter cohort study of patients registered and prospectively followed in the Greek ANCA Registry. Results Data for 165 patients (989.38 patient-years of follow up) with a diagnosis of AAV (GPA n=95, 58%, MPA n=54, 33%, EGPA n=16, 9%) were analyzed (January 1, 1998 - January 10, 2022). 53% of patients were female, with a mean age of 65 (±16.4) years; the majority (97%) had generalized disease and were ANCA positive (76%). The mean follow-up since diagnosis was 5.9 (±5.1) years. At the end of follow-up, the overall mortality rate was 20% (33/165), whereas the cumulative mortality rates at 5 and 10 years were 24% and 26% respectively. Overall cumulative survival at 5 years was worse in patients with MPA (57%) compared to GPA (81%) and EGPA (92%), (p&lt;0.001). There was no difference in long-term survival among those treated with different induction regimens including cyclophosphamide (CYC, n of deaths=24/83, 28.9%), rituximab (RTX, n=4/40, 10%) or the CYC+RTX combination (n=3/16, 18.7%). Furthermore, there was no difference in survival between relapsing (≥1 relapses) and non-relapsing (n=76) patients (Figure 1). Cumulative survival was worse in patients who initially presented with lung (66% vs. 90% at 5 years, p=0.007), kidney (56% vs. 96% at 5 years, p&lt;0.001) and simultaneous lung and kidney (39% vs. 93% at 5 years, p&lt;0.001) involvement. Among the 33 registered deaths, the most frequent causes were infections (52%), followed by cardiovascular events (24%), disease flares (14%) and malignancies (10%). Figure 1. Conclusion In a contemporary multi-center AAV cohort, the cumulative mortality rates at 5 and 10 years were 24% and 26% respectively. Overall survival was worse in patients with MPA as well as those with combined lung and kidney involvement at baseline while there were no survival differences according to the initial induction regimen. Infection was the most common cause of death. These findings emphasize the unmet needs for better, less toxic therapies. Acknowledgements Supported in part by the Greek Rheumatology Society and Professional Association of Rheumatologists (ERE-EPERE) and the Special Account for Research Grants (S.A.R.G.), National and Kapodistrian University of Athens, Athens, Greece (DV #12085, 12086). Disclosure of Interests None declared
AB1562-HPR COMPARING THE PROVISION OF SUBCUTANEOUS METHOTREXATE BETWEEN HOMECARE AND OUTPATIENT PHARMACY; WHAT DO PATIENTS PREFER AND IS ONE ROUTE QUICKER?
Authors: R. Heaton, J. Nasralla, C. Filer, E. Appleby, M. Myintzu
Journal: Annals of the Rheumatic Diseases (2022)

Background The provision of subcutaneous methotrexate has historically been through homecare who provide injection training and delivery. In July 2018, subcutaneous methotrexate was accepted for shared care in the Trust’s locality to reduce medication costs but to also improve safety, reducing the risk of concomitant trimethoprim prescribing. When suitable for shared care, initial injection training is provided by outpatient pharmacists and prescribing and monitoring during the stabilisation period is the responsibility of the rheumatology pharmacy team. Objectives The primary aim of this audit was to compare patient satisfaction between these two different routes of injection training and prescription provision. Additionally, the time it took for a patient to receive their first dose following a decision to start treatment, was also compared. Methods Patients were identified from databases held within the department, contacted retrospectively via telephone and asked to complete a short questionnaire. Clinic letters and the homecare company provided dates of treatment decision and initiation. Results 40 patients were contacted, 20 had received treatment via outpatient pharmacy and 20 via homecare. Table 1. Patient reported satisfaction following receipt of injection training and prescription provision via outpatient pharmacy and homecare Outpatient Pharmacy (20) Homecare (20) Not satisfied Satisfied Very satisfied Not satisfied Satisfied Very satisfied Time taken to start treatment 2 5 13 2 6 12 Injection training 0 4 16 3 5 12 Method for delivery of injection training and initial prescription 1 8 11 3 4 13 Process of receiving repeat prescriptions 1 4 15 1 3 16 The mean time taken to start treatment was 30 days in the homecare group and 13 days in the outpatient group. 7 patients (35%) within the outpatient group started treatment within 7 days. The shortest time within the homecare group was 15 days (3 patients). Conclusion Reported patient satisfaction between the two routes of treatment provision was similar. Patients commenced treatment significantly quicker via outpatient pharmacy, reporting a high degree of satisfaction with the injection training provided by outpatient pharmacists. This audit has confirmed that shared care provision of methotrexate initially via outpatient pharmacy is a safe, efficient and viable option. Disclosure of Interests Rebecca Heaton Speakers bureau: I prepared slides and presented virtually for pharmacists explaining shared care experience (Nordic), Consultant of: Formulating a educational package for rheumatology pharmacists (Galapagos), Jennifer Nasralla: None declared, Charlotte Filer: None declared, Edward Appleby: None declared, Mya Myintzu: None declared
AB0582 TAKAYASU ARTERITIS PRESENTS AT AN OLDER AGE IN EUROPEAN POPULATION
Authors: F. Coath, G. Ducker, T. Eccleston, S. Fordham, C. Mukhtyar
Journal: Annals of the Rheumatic Diseases (2022)

Background The definition of Takayasu arteritis includes the age of onset of disease as being &lt;50 years. It has been reported most frequently in young females from Asian populations. Objectives We investigated whether the epidemiological features are the same in Norfolk, UK, where the population is predominantly of Northern European ancestry. Methods In our centre, cases are classified using validated international criteria. The electronic records of our vasculitis clinic were reviewed to identify all individuals with a new diagnosis of large vessel vasculitis between 2011-2020 who met a modified ACR 1990 criteria for Takayasu arteritis. The original criteria include decreased brachial artery pulse, bruit over subclavian arteries or aorta, and arteriogram abnormality. The respective modifications of these three criteria were to accept decreased radial pulse as well as the brachial pulse, bruit over the axillary artery as well as the subclavian artery, and abnormality of positron emission tomography and/or ultrasonography instead of arteriograms. Results 15 individuals met the modified ACR 1990 criteria for Takayasu arteritis. 2 of them also met the criteria for GCA and were excluded. 13 individuals were classified as having Takayasu arteritis. 11 were female. The mean (standard deviation) age at diagnosis was 66.9 (8.9) years. None of individuals were &lt;40 years old. On presentation - 9 had upper limb claudication, 7 had pulse discrepancy, 3 had a blood pressure difference &gt;10 mm Hg systolic, 7 had an audible bruit over either subclavian or axillary artery. The diagnosis was confirmed on positron emission tomography in 8. Ultrasonography of extracranial arteries was abnormal in 7. The mean (standard deviation) ESR was 53.2 (33.6) and CRP was 37.5 (32.8). Conclusion Takayasu arteritis can present at an older age in Norfolk, UK, where the population predominantly has Northern European ancestry. This has implications for treatment, identification of immunogenetic factors and disease classification. References [1]Arend WP et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 1990; 33(8), 1129-34. Disclosure of Interests None declared
Dipeptidyl peptidase-4 inhibitors and gallbladder or biliary disease in type 2 diabetes: systematic review and pairwise and network meta-analysis of randomised controlled trials
Authors: Liyun He, Jialu Wang, Fan Ping, Na Yang, Jingyue Huang, Wei Li, Lingling Xu, Huabing Zhang, Yuxiu Li
Journal: BMJ (2022)

Abstract Objective To examine the association between dipeptidyl peptidase-4 inhibitors and gallbladder or biliary diseases. Design Systematic review and pairwise and network meta-analysis. Data sources PubMed, EMBASE, Web of Science, and CENTRAL from inception until 31 July 2021. Eligibility criteria Randomised controlled trials of adult patients with type 2 diabetes who received dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter-2 inhibitors compared with placebo or other antidiabetes drugs. Main outcome measures Composite of gallbladder or biliary diseases, cholecystitis, cholelithiasis, and biliary diseases. Data extraction and data synthesis Two reviewers independently extracted the data and assessed the quality of the studies. The quality of the evidence for each outcome was assessed using the Grading of Recommendations, Assessment, Development and Evaluations framework (GRADE) approach. The meta-analysis used pooled odds ratios and 95% confidence intervals. Results A total of 82 randomised controlled trials with 104 833 participants were included in the pairwise meta-analysis. Compared with placebo or non-incretin drugs, dipeptidyl peptidase-4 inhibitors were significantly associated with an increased risk of the composite of gallbladder or biliary diseases (odds ratio 1.22 (95%confidence interval 1.04 to 1.43); risk difference 11 (2 to 21) more events per 10 000 person years) and cholecystitis (odds ratio 1.43 (1.14 to 1.79); risk difference 15 (5 to 27) more events per 10 000 person years) but not with the risk of cholelithiasis and biliary diseases. The associations tended to be observed in patients with a longer duration of dipeptidyl peptidase-4 inhibitor treatment. In the network meta-analysis of 184 trials, dipeptidyl peptidase-4 inhibitors increased the risk of the composite of gallbladder or biliary diseases and cholecystitis compared with sodium-glucose cotransporter-2 inhibitors but not compared with glucagon-like peptide-1 receptor agonists. Conclusions Dipeptidyl peptidase-4 inhibitors increased the risk of cholecystitis in randomised controlled trials, especially with a longer treatment duration, which requires more attention from physicians in clinical practice. Systematic review registration PROSPERO CRD42021271647.
AB0402 THERAPEUTIC ADHERENCE AND PERSISTENCE OF TOFACITINIB AND BARICITINIB IN RHEUMATOID ARTHRITIS PATIENTS IN DAILY CLINICAL PRACTICE.
Authors: H. Codes-Mendez, C. Martinez-Molina, M. Masip, P. Riera, N. Pagès Puigdemont, A. Riera Magallón, D. Lobo Prat, L. Sainz Comas, H. Corominas, C. Díaz-Torné
Journal: Annals of the Rheumatic Diseases (2022)

Background The use of Janus kinase inhibitors (JAKi) is approved for adults with rheumatoid arthritis (RA) with moderate to severe activity. Although there is increasing data about baricitinib and tofacitinib in daily clinical practice, data about adherence and persistence in real-life is scarce. Objectives (i) To evaluate the adherence and persistence of tofacitinib and baricitinib in RA patients in a real-life setting. (ii) To assess the influence of treatment adherence to therapeutic persistence. Methods Retrospective longitudinal observational study that included all patients with RA who were treated with tofacitinib and/or baricitinib between 2017/10 and 2021/05 in a tertiary hospital. Demographic, clinical and pharmacological data were collected from electronic medical and pharmacy claim records. Kaplan-Meier survival analysis and log-rank test were performed to calculate and compare treatment persistence, respectively. Drug adherence was assessed with the Medication Possession Ratio (MPR). The effect of therapeutic adherence on treatment persistence was evaluated with a linear regression model. Results We included 136 cases: 30 treated with tofacitinib [28.6%], 44 with baricitinib [41.9%] and 31 with both [29.5%] corresponding to 105 RA patients. In our sample 86.7% of the patients were women with a mean age (± SD) of 63 (± 13) years. At the start of treatment, patients had a mean disease activity score DAS28-ESR (± SD) of 5.1 (± 1.2) and they had previously received a median (range) of 3 (0-8) biologic agents for RA. During the study period, 40 (29.4%) and 38 (27.9%) patients treated with tofacitinib and baricitinib, respectively, discontinued the treatment. Mean treatment persistence was 363 days (95%CI=2-1.282) in tofacitinib group and 406 days (CI95%=8-1.300) in baricitinib group. There were no statistical differences in treatment survival (HR=1.01 [95CI%=0.59-1.71]; p=0.97). Mean MPR was 91% in both groups. There was no statistically significant correlation between therapeutic adherence and treatment persistence (p=0.21). Conclusion The results showed no significant differences between treatment persistence and adherence of tofacitinib and baricitinib in our patients with rheumatoid arthritis. In our cohort, therapeutic adherence was high and it did not influence treatment persistence. Disclosure of Interests None declared
AB1402 FACILITATORS AND BARRIERS OF VACCINE UPTAKE IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASE: A SCOPING REVIEW
Authors: S. Neusser, A. Neumann, C. Speckemeier, P. Zur Nieden, S. Schlierenkamp, A. Walendzik, U. Karbach, I. Andreica, K. Vaupel, X. Baraliakos, U. Kiltz
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with chronic inflammatory rheumatic diseases (CIRD) remain underrepresented in receiving vaccinations despite being disproportionately affected by infectious complications. Objectives To systematically review the literature regarding vaccination willingness and vaccination hesitancy in CIRD patients with focus on the perspective of patients and physicians. Methods A scoping review was conducted in PUBMED, EMBASE and the Cochrane Library through 2021. Study selection was performed by two independent reviewers, data were extracted using a standardized form and risk of bias was assessed using instruments from the McMaster University. Identified barriers and hurdles were synthesized by categorizing them into the WHO’s Measuring Behavioural and Social Drivers of Vaccination (BeSD) conceptual model. Results The search yielded 1,644 hits, of which 30 were included (cross-sectional studies (n=27) based on interviews and 3 intervention studies). The majority of studies reported barriers to influenza and pneumococcal vaccination (n=11), or influenza vaccination only (n=9) from the patients perspective. Two studies assessed the attitudes towards COVID-19 vaccinations. Only one study assessed the view of rheumatologists. Patients mainly mentioned behavioral and social factors that negatively influence their willingness to be vaccinated while physicians see deficits in the organization and lack of time as a major barrier. Coverage of domains matched to the BeSD model suggests a lack of awareness of infection risk by both patients and physicians (Figure 1). Figure 1. Coverage of domains matched to the WHO BeSD Model Conclusion The view of vaccination in CIRD patients diverges between patients and rheumatologists. Our results show that in-depth counseling on vaccines is important for patients, whereas physicians need support in implementing specific immunization recommendations. The themes identified provide a starting point for future interventions to improve vaccine rates in CIRD patients. Disclosure of Interests None declared
AB0020 COMPARATIVE DESCRIPTION OF CYTOKINES AND MATRIX METALLOPROTEINASES IN A GROUP OF PATIENTS WITH RHEUMATOID ARTHRITIS AND OSTEOARTHROSIS UNDER A STRICT FOLLOW-UP COMPARED WITH COVID-19 PATIENTS
Authors: S. Navarrete, L. D. Gutiérrez-Castañeda, P. K. Bautista-Niño, J. A. Rubio-Rubio, G. S. Rodríguez-Vargas, P. Santos-Moreno, D. Echeverri, L. Saenz, L. Torres Tobar, A. Aparicio, A. Rojas-Villarraga, F. Sierra-Matamoros
Journal: Annals of the Rheumatic Diseases (2022)

Background COVID-19, rheumatoid arthritis (RA) and osteoarthrosis (OA) are diseases characterized by the secretion of cytokines related to the stimulation of the inflammatory response. Objectives To identify the differences in the cytokine and matrix metalloproteinases (MMP) profile within one acute infectious disease and two chronic inflammatory rheumatic diseases. Methods Analytical cross-sectional study. RA patients under a strict follow-up program (T2T evaluated every two months), OA patients without strict clinical follow-up, evaluated once or twice a year, and Severe (mortality) COVID-19 patients were included. Eleven proteins (cytokines, MMPs and its tissue inhibitors) were quantified through Luminex multiplex assay in serum samples. Univariate and bivariate analyzes were performed. Approval of Ethics Committee and informed consent were obtained. Results A total of 108 patients with RA and OA were compared with 20 severe COVID-19 patients. There were no significant differences through the method of Kruskall–Wallis, between RA and OA patients. IL1-B and MMP-2 were significantly lower in COVID-19 patients. Levels of IL-10, IL-1RA, IL-6, MMP-1, MMP-9, and TIMP-1 were significantly higher in COVID-19 patients. There were no differences in TNF-A, TIMP-2 and INF-G. (Table 1) Table 1. Significant correlations between cytokines related to Covid-19, RA and OR. Cytokine (pg/ml) Median values RA (%) OA COVID-19 P-value IL-10 54.92 54.49 116.38 &lt;0.0001 a Il1-RA 62.19 51.82 110.08 &lt;0.0001 a IL1-B 67.09 55.30 46.17 0.045 IL-6 56.09 51.34 84.98 &lt;0.0001 b 0.003 c TNF-A 17.5 14.6 16.3 NS MMP-1 d 57.84 54.84 90.81 &lt;0.0001 b 0.045 c MMP-2 d 70.38 70.59 48.56 0.040 MMP-9 d 66.25 58.16 86.4 0.007 b TIMP-1 d 51.59 60.99 111.67 &lt;0.0001 a TIMP-2 d 45.2 47.7 49.6 NS INF-G 5.75 5.32 3.07 NS a Between RA and Covid-19 and OA and Covid-19, without differences between RA and OA. b Between OA and Covid-19. C Between RA and Covid-19. d ng/ml. Conclusion Compared with RA and OA patients, severe COVID-19 patients have a great impact on the cytokines and MMPs addressed in this study, proving that COVID-19 patients suffer from a cytokine storm [1] when severely infected. References [1]R. Mulchandani, T. Lyngdoh, and A. K. Kakkar, “Deciphering the COVID-19 cytokine storm: Systematic review and meta-analysis,” Eur. J. Clin. Invest. , vol. 51, no. 1, pp. 1–21, 2021, doi: 10.1111/eci.13429. Disclosure of Interests None declared
POS1515-HPR CONJUGAL RELATIONSHIPS IN MARRIED PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATISMS
Authors: O. Hamdi, S. Jemmali, S. Boussaid, S. Rahmouni, S. Rekik, H. Sahli, M. Elleuch
Journal: Annals of the Rheumatic Diseases (2022)

Background The consequences of chronic inflammatory rheumatisms (CIR) on the sexuality and the relationships between the subject and his/her partner are still underestimated and insufficiently studied. Objectives The aim of this study was to investigate the impact of CIR on conjugal relationships. Methods We conducted a cross-sectional study involving patients with rheumatoid arthritis (RA) (2010 ACR/EULAR criteria) and spondyloarthritis (SpA) (2009 ASAS criteria). All the patients included in the study were married. We collected demographic data, and participants were asked to complete a questionnaire on their conjugal relationships. Results We enrolled 75 patients (40 RA and 35 SpA) with a sex ratio of 0.4 and a mean age of 55.35 ± 9.81 years [22-85]. The mean chronic CIR duration was 11.85 ± 3.4 years. The mean duration of marriage was 9.5 ± 2.6 years. The mean age at marriage was 27 ± 6.41 years [19-33]. The mean number of off-springs was 4. Forty-nine percent of patients and 22.3% of the partners had a profession, respectively. Forty one percent of the partners had a chronic disease: diabetes (n=12), hypertension (n=10), dyslipidemia (n=7), CIR (n=7), coronary disease (n=3), and other conditions (n=5). A psychiatric illness was noted in 22.6% of cases: depression (n=9), anxiety (n=6), and bipolar disorder (n=2). Sixty-four percent of patients consider their spouses sympathetic to their illness. Eighty-nine percent of participants have noticed a change in their life as a couple before and after the CIR onset. According to 64% of participants, the CIR had a negative impact on their married lives. The spouses’ emotional reactions to the disease were as follows: indifference (30.6%), denial (29.3%), anger (26.6%), and fear (13.6%). Patients reported being accompanied by their spouses to their medical appointments in 36% of cases, and 40% of them were asked questions by their spouses about their disease and treatment. The CIR has resulted in the termination of the marriage in 2.6% of cases. Conclusion Patients suffering from chronic diseases such as CIR are more frequently exposed to difficulties in their conjugal relationships. The disease has thus important consequences on the subject’s quality of life, emotional and interpersonal state. A better compliance with the chronic disease and its treatment may improve the couples’ relationships. Disclosure of Interests None declared
Bacterial outer membrane vesicles-based therapeutic platform eradicates triple-negative breast tumor by combinational photodynamic/chemo-/immunotherapy
Authors: Yongjiang Li, Junyong Wu, Xiaohan Qiu, Suhe Dong, Jun He, Jihua Liu, Wenjie Xu, Si Huang, Xiongbin Hu, Da-Xiong Xiang
Journal: Bioactive Materials (2022)

Bacterial outer membrane vesicles (OMVs) are potent immuno-stimulating agents and have the potentials to be bioengineered as platforms for antitumor nanomedicine. In this study, OMVs are demonstrated as promising antitumor therapeutics. OMVs can lead to beneficial M2-to-M1 polarization of macrophages and induce pyroptosis to enhance antitumor immunity, but the therapeutic window of OMVs is narrow for its toxicity. We propose a bioengineering strategy to enhance the tumor-targeting ability of OMVs by macrophage-mediated delivery and improve the antitumor efficacy by co-loading of photosensitizer chlorin e6 (Ce6) and chemotherapeutic drug doxorubicin (DOX) into OMVs as a therapeutic platform. We demonstrate that systemic injection of the DOX/Ce6-OMVs@M therapeutic platform, providing combinational photodynamic/chemo-/immunotherapy, eradicates triple-negative breast tumors in mice without side effects. Importantly, this strategy also effectively prevents tumor metastasis to the lung. This OMVs-based strategy with bioengineering may serve as a powerful therapeutic platform for a synergic antitumor therapy.